Provider Demographics
NPI:1063964344
Name:SMITH, TAWNI MARLEY (CST)
Entity type:Individual
Prefix:
First Name:TAWNI
Middle Name:MARLEY
Last Name:SMITH
Suffix:
Gender:F
Credentials:CST
Other - Prefix:
Other - First Name:TAWNI
Other - Middle Name:MARLEY
Other - Last Name:PACE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CST
Mailing Address - Street 1:135 N HILL ST
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30223-3326
Mailing Address - Country:US
Mailing Address - Phone:678-972-0166
Mailing Address - Fax:
Practice Address - Street 1:135 N HILL ST
Practice Address - Street 2:
Practice Address - City:GRIFFIN
Practice Address - State:GA
Practice Address - Zip Code:30223-3326
Practice Address - Country:US
Practice Address - Phone:678-972-0166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA163942246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist